title: A prospective, double-blind, randomized, controlled clinical trial comparing standard wound care with adjunctive hyperbaric oxygen therapy (HBOT) to standard wound care only for the treatment of chronic, non-healing ulcers of the lower limb in patients with diabetes mellitus: a study protocol.
abstract: BACKGROUND
  It has been suggested that the use of adjunctive hyperbaric oxygen therapy improves the healing of diabetic foot ulcers, and decreases the risk of lower extremity amputations. A limited number of studies have used a double blind approach to evaluate the efficacy of hyperbaric oxygen therapy in the treatment of diabetic ulcers. The primary aim of this study is to assess the efficacy of hyperbaric oxygen therapy plus standard wound care compared with standard wound care alone in preventing the need for major amputation in patients with diabetes mellitus and chronic ulcers of the lower limb.
  
  
  METHODS
  One hundred and eighteen (59 patients per arm) patients with non-healing diabetic ulcers of the lower limb, referred to the Judy Dan Research and Treatment Centre are being recruited if they are at least 18 years of age, have either Type 1 or 2 diabetes with a Wagner grading of foot lesions 2, 3 or 4 on lower limb not healing for at least 4 weeks. Patients receive hyperbaric oxygen therapy every day for 6 weeks during the treatment phase and are provided ongoing wound care and weekly assessments. Patients are required to return to the study centre every week for an additional 6 weeks of follow-up for wound evaluation and management. The primary outcome is freedom from having, or meeting the criteria for, a major amputation (below knee amputation, or metatarsal level) up to 12 weeks after randomization. The decision to amputate is made by a vascular surgeon. Other outcomes include wound healing, effectiveness, safety, healthcare resource utilization, quality of life, and cost-effectiveness. The study will run for a total of about 3 years.
  
  
  CONCLUSIONS
  The results of this study will provide detailed information on the efficacy of hyperbaric oxygen therapy for the treatment of non-healing ulcers of the lower limb. This will be the first double-blind randomized controlled trial for this health technology which evaluates the efficacy of hyperbaric oxygen therapy in prevention of amputations in diabetic patients.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT00621608.
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. oreilld@mcmaster.ca
authors.forename: Daria
authors.initials: D
authors.lastname: O'Reilly
authors.forename: Ron
authors.initials: R
authors.lastname: Linden
authors.forename: Ludwik
authors.initials: L
authors.lastname: Fedorko
authors.forename: Jean-Eric
authors.initials: JE
authors.lastname: Tarride
authors.forename: Wilhelmine Giffening
authors.initials: WG
authors.lastname: Jones
authors.forename: James M
authors.initials: JM
authors.lastname: Bowen
authors.forename: Ron
authors.initials: R
authors.lastname: Goeree
mesh_terms: D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001458:Bandages; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003646:Debridement; D003925:Diabetic Angiopathies / Q000473:pathology / Q000628:therapy*; D004311:Double-Blind Method; D006801:Humans; D006931:Hyperbaric Oxygenation; D007871:Leg Ulcer / Q000473:pathology / Q000628:therapy*; D023821:Limb Salvage; D009864:Ontario; D011446:Prospective Studies; D012107:Research Design; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents